Changes in prescribing symptomatic and preventive medications in the last year of life in older nursing home residents

van der Meer, HG; Taxis, K; Pont, LG

Changes in prescribing symptomatic and preventive medications in the last year of life in older nursing home residents

van der Meer, HG Taxis, K Pont, LG

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Publication Type:: Journal Article
Citation:: Frontiers in Pharmacology, 2018, 8 (JAN)
Issue Date:: 2018-01-23

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Field	Value	Language
dc.contributor.author	van der Meer, HG	en_US
dc.contributor.author	Taxis, K	en_US
dc.contributor.author	Pont, LG https://orcid.org/0000-0002-8545-716X	en_US
dc.date.issued	2018-01-23	en_US
dc.identifier.citation	Frontiers in Pharmacology, 2018, 8 (JAN)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/128268
dc.description.abstract	© 2018 van der Meer, Taxis and Pont. Background: At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage. Objectives: To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents. Methods: A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged = 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life. Results: 68.1% of residents were female, mean age was 88.0 (SD: 7.5) years and residents used a mean of 9.1 (SD: 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4-4.7 to 5.9-5.2, P = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9-2.1 to 1.3-1.5, P = 0.000]. Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8-340.8] versus 310.9 days [95% CI 305.2-316.7], P = 0.000). Conclusion: Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.	en_US
dc.relation.ispartof	Frontiers in Pharmacology	en_US
dc.relation.isbasedon	10.3389/fphar.2017.00990	en_US
dc.title	Changes in prescribing symptomatic and preventive medications in the last year of life in older nursing home residents	en_US
dc.type	Journal Article
utslib.citation.volume	JAN	en_US
utslib.citation.volume	8	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	JAN	en_US
pubs.publication-status	Published	en_US
pubs.volume	8	en_US

Abstract:

© 2018 van der Meer, Taxis and Pont. Background: At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage. Objectives: To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents. Methods: A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged = 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life. Results: 68.1% of residents were female, mean age was 88.0 (SD: 7.5) years and residents used a mean of 9.1 (SD: 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4-4.7 to 5.9-5.2, P = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9-2.1 to 1.3-1.5, P = 0.000]. Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8-340.8] versus 310.9 days [95% CI 305.2-316.7], P = 0.000). Conclusion: Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.

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http://hdl.handle.net/10453/128268